Academic Exchange Quarterly  Fall 2011 ISSN 1096-1453 Volume 15, Issue 3

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BSN Students' Perceptions of Service Learning

 

Kristin Whitty, Southeastern Louisiana University

Catherine Cormier, Louisiana State University

Kenneth Tillman, Southeastern Louisiana University

 

Whitty, PhD, is Assistant Professor at Southeastern Louisiana University in Nursing, Cormier, PhD, is Assistant Professor at Louisiana State University in Nursing, and Tillman, PhD is Assistant Professor at Southeastern Louisiana University in Nursing

 

Abstract

The purpose of this study was to measure student attitudes and perceptions of community service, preference for workplace setting post-graduation, and knowledge of community resources and barriers to health care before and after participation in a community health experience. Findings revealed that the student attitudes and perceptions related to community service participation were significantly higher, and that their knowledge of community resources and community services significantly increased, following participation in the service learning project.

 

Introduction

The concept of service is intrinsic to the practice of nursing (Seifer & Vaughn, 2002), and nurse educators work to foster partnerships with community leaders in planning service learning experiences that enrich their student’s education.  Cauley, Canfield, Clasen, Dobbins, Hemphill, Jaballas and Walbroehl (2001)described the usefulness of service learning experiences in the clinical education of health professionals, citing increased community partnerships, additional clinical training sites, exposure to diverse patient populations, increased awareness of community resources as benefits, and helping to instill a greater ethic of service in future health care providers. The advantages of integrating community health experiences and service learning within the nursing curriculum are well documented in the literature (Bentley & Ellison, 2005; Hamner, Wilder, & Byrd, 2007; Kelly, Kun & Salmon, 2008; Lashley, 2007; Sensenig, 2007; Ward, Blair, Jackson, Landolt & Mattson, 2007; Bassi, Cray, & Caldrello, 2008); however, empirical data to support evidenced based practice in undergraduate nursing education are limited (Reising, Shea, Allen, Laux, Hensel & Watts,  2008). 

 

Data showing positive student outcomes following service learning experiences of other healthcare disciplines have been reported in the literature.  Younghee, Clasen and Canfield (2003) studied the effectiveness of service learning as a teaching methodology in dietetics education. They found the most significant change in the participants’ attitude toward service learning to be their desire to work in settings where health care professionals are under-represented and that participants’ knowledge of community resources, health care needs, barriers to receiving care, impact of socioeconomic status on health, and how to work with clients, significantly increased.  Canfield, Clasen, Dobbins, Cauley, Hemphill, Rodney and Walbroehl  (2000) described the use of service learning principles in teaching a course consisting of nursing, medicine, psychology, social work, dental hygiene, and other allied health students. The researchers reported that students had a significant difference in their self-reported knowledge of community resources, healthcare needs, and barriers to receiving health care and that the majority of students were willing to participate in future service learning activities.

 

This paper will describe a service learning experience that allowed baccalaureate nursing students to work with residents of a community following a natural disaster.  The results of a study to measure the students’ attitudes and perceptions of community service, preference for workplace setting post-graduation, and knowledge of community resources and barriers to health care before and after participation in the service learning experience will be presented.  Hopefully, sharing the findings from this study will encourage other nursing faculty to seek ways to incorporate hands-on experiences in community settings and increase service learning experiences in nursing curricula.

 

Description of the Service Learning Project

The purpose of this study was to measure student attitudes and perceptions of community service, student preference for workplace setting post-graduation, and student knowledge of community resources and barriers to health care before and after participation in a community health experience. The community health service learning experience used in this study was a disaster relief health clinic that operated for a 7-day period in 2007.   The event, called “Medical Recovery Week,” was organized by multiple public and private local, state, and national agencies. The purpose of the clinic was to provide residents of a metropolitan area access to healthcare services during the recovery phase of a natural disaster. The clinic provided a variety of primary, secondary, and tertiary services in which more than 400 doctors, nurses and dentists from across the United States volunteered to provide over 10,000 medical services.

 

Participants were recruited from four clinical groups at a school of nursing at a regional state university.  Thirty-one students initially volunteered to participate, but one student elected to withdraw from the study. Clinical instructors provided a brief description of the purpose of the study, guaranteed students confidentiality, and assured students that participation or non-participation in the study would not affect their clinical grade. Participants were notified  that completion of the survey indicated informed consent and that the study would require completion of two surveys.

 

A mixed methodology design was utilized in this study.  A quantitative design was used to assess the impact of participation in the community clinic on attitudes and perceptions of community service, preference for workplace setting post-graduation, and perceived knowledge of community resources and barriers to health care among baccalaureate nursing students. A qualitative design was utilized to analyze data obtained from open-ended questions to identify themes from participants’ responses.

 

The Service Learning Instrument-Health Professional (SLI-HP) survey developed by the Center of Health Communities Student Survey at Wright State University (Lovell, White, Thatcher, Mayle, Willis, Ramboldo & Meyer, 1999) was used following granted permission from the instrument developers. The SLI-HP included both a pre- and post-test, and according to Lovell et al. (1999) as cited by George and Mallery (2003) has a good reliability rating (a = .85). The SLI-HP pre-test included three sections. The first section included 11 variables designed to describe the characteristics of participants. The second section consisted of 15 questions designed to measure participants’ attitudes and perceptions of community service. The third section directed participants to respond to eight items related to preference for workplace setting post-graduation. In addition to sections two and three from the pre-test, the post-test included nine items that measured participants’ perceived knowledge of community resources and barriers to health care, and four open-ended questions related to the service learning experience.

 

Data entry and analysis were conducted using SPSS.  Measures of central tendency were used to report demographic data. Changes in attitudes and perceptions, student preference for workplace setting post-graduation, and student perceived knowledge of community resources and barriers to health care in the pre-post test were measured using the dependent t-test statistic. Qualitative methods were used to analyze data obtained from the four open-ended questions in Section 4 to identify themes from participants’ responses.

 

Impact of the Service Learning Project

The participants ranged in age from 20 to 48 years, and the majority was Caucasian and female.  During their previous school clinical experiences, their employment, and as volunteers, participants reported having been exposed to multiple hospital sites; however, they indicated having few experiences in the community setting. Demographic data are presented in Table 1.

 

To determine changes in attitudes and self-perceptions, students were asked questions regarding 15 items using a seven-point scale from strongly agree (1) to strongly disagree (7) related to community service participation before and after participation in the service learning project. The results showed that participation in the activity significantly impacted their attitudes and perceptions of health care in the community setting. To determine changes in desired workplace setting post-graduation, students were asked questions regarding eight items using a seven-point scale from very willing (1) to very unwilling (7) related to various settings before and after participation in the service learning project.. The results showed that participation did not significantly impact their desired workplace settings post-graduation.  To determine changes in knowledge regarding community resources, students were asked questions regarding nine items related to community resources and community service before and after participation in the service learning project. The results showed that participation in the service learning activity significantly increased their knowledge of community resources and community (See Table 2).

Dependent t-test analyses revealed significant differences pre-service learning and post-service learning experience in knowledge gained regarding community resources and attitudes toward community service (See Table 3).

 

Participants were asked to respond to four open-ended questions on the post-test. In response to the first question, “Please list the reflection activities that you participated in throughout this experience,” most participants identified discusssions, journaling, and question /answer sessions. As participants were only briefly oriented to their assigned areas once they arrived, no data was obtained in response to the open-ended question, “Did you receive a formal orientation to your placement site before first reporting there for services?” 

Several themes did emerge from responses to the last two open-ended questions. In response to the third question, “Do you feel you have acquired new skills or enhanced existing skills as a result of this experience,” the three themes that emerged included: increased assessment skills, increased communication skills, and increased experience in working with culturally/ethnically diverse populations. Some of the student responses that illustrated these themes are in Table 4.

In response to the fourth open-ended question, “Do you think that you have gained unique knowledge from this clinical/training experience,” three distinct themes emerged from the data. These themes included: knowledge of community needs, knowledge of ethnic/cultural groups, and knowledge not available in a class/school setting. See Table 4 for some of the student responses.

  

Conclusion

For student nurses in this study, attitudes and perceptions related to community service participation were higher following participation in the service learning project. This change from “agree” to “strongly agree” was evident on the seven-point scale used to measure the 15 items related to attitudes and self-perceptions.  The nursing students who participated in this service learning study became more knowledgeable of community resources and community services.  This change from “little knowledge” to “moderate-high knowledge” was evident on the five-point scale used to measure the nine items related to community resources and services. The responses by participants to the four open-ended questions, specifically the third and fourth questions, revealed that student participants perceived they gained new skills or enhanced existing skills, and gained unique knowledge through participation in the service learning project.

 

Based on these conclusions, the researchers recommend that service learning opportunities be incorporated into nursing curricula. The hands-on experience gained through service learning participation in the community enhances student’s attitudes and perceptions of community-based nursing, knowledge of community resources, and allows students opportunities to refine skills such as assessment and communication. These experiences cannot be achieved by merely learning about the community within the confines of the academic setting. As in this study, faculty should seek-out timely and current opportunities that partner students with events or organizations that are addressing community health needs. There were several limitations of this study. These included a small convenience sample of predominately Caucasian female nursing students within one nursing program. In addition, student participants in this study did not receive any type of structured orientation to the service learning project prior to arriving at the event. Recommendations for future research include using a larger and more diverse sample. It would be useful to also compare attitudes and beliefs among students at different levels in nursing programs and across different programs. Finally, future research could evaluate whether or not a structured orientation prior to participating in a service learning project influences students’ attitudes and perceptions.

 

References

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Bentley, R. & Ellison, K. (2005). Impact of a service-learning project on nursing students. Nursing Education Perspectives, 26(5), 287-297.

Canfield, A, Clasen, C., Dobbins, J., Cauley, K., Hemphill, S., Rodney, M., & Walbroehl, G. (Winter 2000). Service-learning in health professions education: A multiprofessional example. Academic Exchange Quarterly, pp. 102-108.

Cauley, K., Canfield, A., Clasen, C., Dobbins, J., Hemphill, S., Jaballas, E. & Walbroehl, G. (2001). Service learning: Integrating student learning and community service. Education for Health, 14(2), 173-181. doi: 10.1080/13576280110057563

George, D. & Mallery, P. (2006). SPSS for Windows step-by-step: A simple guide and reference, 14.0 update (7th ed.). Boston: Allyn & Bacon.

Hamner, J., Wilder, B., & Byrd, L. (2007) Lessons learned: integrating a service learning community-based partnership into the curriculum. Nursing Outlook, 55(2), 106-110.

Lashley, M. (2007). Nurses on a mission: A professional service learning experience with the inner-city homeless. Nursing Education Perspectives, 28(1), 24-26.

Lovell, T., White, K., Thatcher, T., Mayle, A., Willis, T., Ramboldo, L…Meyer, C. (1999). Service Learning Instrument-Health Professional (SLI-HP). Center for Healthy Communities, Wright State University. Retrieved from http://www.eric.ed.gov/PDFS/ED440125.pdf

Reising, D., Shea, R., Allen, P., Laux, M., Hensel, D., & Watts, P. (2008). Using service-learning to develop health promotion and research skills in nursing students. Journal of Nursing Education Scholarship, 5(1), 1-15.

Seifer, S. & Vaughn, R. (2002). Partners in caring and community: Service-learning in nursing education. Journal of Nursing Education, 41(10), 437-439.

Sensenig, J. (2007). Learning through teaching: Empowering students and culturally diverse patients at a community-based nursing care center. Journal of Nursing Education, 46(8), 373-379.

Younghee, K., Clasen, C. & Canfield, A. (2003). Effectiveness of service learning and learning through service in dietetics education. Journal of Allied Health, 32(4), 275-278.

Ward, S., Blair, M., Jackson, H., Landolt, T., & Mattson, K. (2007). Educational innovations: Service-learning across an accelerated curriculum. Journal of Nursing Education, 46(9), 427-430.